Perioperative medicine & outcomes
Trends and In-Hospital Mortality for Perioperative Myocardial Infarction After the Introduction of a Diagnostic Code for Type 2 Myocardial Infarction in the United States Between 2016 and 2018
Authors' conclusion
The frequency of perioperative myocardial infarctions did not increase after the introduction of a new diagnostic code for type 2 myocardial infarctions. A diagnosis of type 2 myocardial infarction was not associated with increased in-patient mortality; however, few patients received invasive management that may have confirmed the diagnosis.
Study context
- Population
- US hospital discharges with primary intrathoracic, intraabdominal or suprainguinal vascular surgery, National Inpatient Sample (NIS) 2016–20181,801,239 weighted discharges
- Participants
- 360,264 participants
- Exposure
- ST elevation myocardial infarction (STEMI) vs non-ST elevation myocardial infarction (NSTEMI) vs Type 2 MI
- STEMIn = 405
- NSTEMIn = 2,090
- Type 2 MIn = 2,085
- Outcome
- Change in frequency of perioperative MI after introduction of type 2 MI code; association with in-hospital mortality
Methodological detailsNational Inpatient Sample, segmented logistic regression, multivariable logistic regression
- National Inpatient Sample
- Segmented logistic regression
- Multivariable logistic regression
Main finding
As reported in the abstract
Monthly frequency of perioperative MI
Odds ratio (95% CI)P value
Before code introduction (baseline trend)small baseline decrease
0.992(0.984–1.000)
P = 0.042After code introduction (change in trend)no change in trend
0.998(0.991–1.005)
P = 0.50- Overall incidence of MI
- 0.76% (13,605/1,801,239)
Observational data: associations, not effects.
Further findings
Distribution of MI type · 2018
In-hospital mortality by MI type
| OR (95% CI) | P value | ||
|---|---|---|---|
| STEMI | 8.96 (6.20–12.96) | P < 0.001 | |
| NSTEMI | 1.59 (1.34–1.89) | P < 0.001 | |
| Type 2 MI | 1.11 (0.81–1.53) | P = 0.50 | |
| 0.050.21520Odds ratio (log scale) |
- Distribution of MI type: denominator 4580
- In-hospital mortality by MI type: adjusted for surgical procedure, comorbidities, demographics, hospital characteristics
Original publication
Trends and In-Hospital Mortality for Perioperative Myocardial Infarction After the Introduction of a Diagnostic Code for Type 2 Myocardial Infarction in the United States Between 2016 and 2018. Anesth Analg. Published 16 February 2023. doi:10.
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